We analysed outcomes of IAA repair using a standardised technique in order to interpret the role of the arch repair on late outcomes in this complex and heterogeneous group.
Single institution study from 1988-2015. 120 cases of IAA were divided into four groups: IAA with VSD (iVSD, n=38), IAA with Norwood/DKS (iNor, n=41), IAA with Truncus (iTruncus, n=24) and miscellaneous group (iMisc, n=17). Arch repair performed using a standard technique of direct anastomosis with homograft patch augmentation.
IAA were predominantly Type B (n=81, 68%), and Type A (n=34, 28%), with a significant association of type B with truncus, and type A with AP window (p<0.01). Survival was similar in all groups. The incidence of catheter or surgical re-intervention was 18% (CI 10-25%) at 5 years and 18% (CI 10-25%) at 10 years, with catheter reintervention more common and occurring before 18 months. Surgical reintervention occurred in 7% (CI 2-13%) at 5 and 10 years, and was lower in the iTruncus (0%) and iNor (5%) at 10 years. There was no bronchial obstruction or aortic aneurysm. Cox proportional hazard model showed that weight at surgery <2.5kg and era of surgery were predictive of outcome, with surgical mortality in all variants dropping to 8.3% in the last 15 years of the study.
Repair of IAA using direct anastomosis and patch augmentation is applicable to all variants and provides good long-term arch patency. Survival is strongly associated with weight at surgery.